As part of his internship, Trey is working night intake at apsychiatric hospital in a medium-sized college town. It's beenpretty quiet all evening until a little after 1 a.m. when he hearsshouting in the outer hallway.
Trey looks at Lisa, his fellow student intern, who says, \"What'sgoing on out there?\"
A moment later the doors burst open, and a young man, who looksabout 18 years old, is escorted into the intake desk. He isagitated and has tears on his face, but he is not showing signs ofviolence or aggression, beyond the brief shouting he did out in thehallway.
He plunks himself down in the chair across from the intake desk andburies his face in his hands, rocking slightly and moaning. He hasa slight body odor and is perspiring heavily.
\"He's all yours,\" Lisa whispers.
Trey ignores her and moves quickly to the intake desk. Lisa runsoff to find the supervising nurse, who has gone on break.
\"Hey there,\" Trey says calmly, bending over to look into thepatient's eyes. \"I'm Trey. What's up?\"
He is almost surprised when the patient stops rocking, sits up, andlowers his hands. \"Hey,\" he says quietly. \"I'm Matt, and this ishell, dude.\"
\"Not quite,\" Trey smiles. \"I'm here to help. Can you tell me what'shappened?\"
\"I'm going all to pieces,\" Matt says, \"little screws and bolts anddebris flying off everywhere.\"
Trey says nothing; he just waits.
\"I had kind of a breakdown in my dorm,\" Matt says. \"I threw mylaptop out the window.\"
\"Ooh, that's rough. Bad night, huh?\"
\"Bad week, bad month, bad year, bad bad life. Badbadbadbadbadbadbadbad BA-A-A-AD.\"
\"What happened?\"
\"Where you wanna start?\"
In fits and starts, Matt conveys small clues that hint at hisstory.
Matt has always been a \"nerd,\" he says, according to his olderbrothers. As a child, he often withdrew from playgroups at schoolto play on his own. In isolation, he has always managed to performwell academically, but in group work or group assignments, he hastended to resort to outbursts and a refusal to participate. He sayshe has always been awkward in social situations and has alwaysfound it hard to carry on \"a good, rewarding conversation.\"
\"And I'm freakin' clumsy. Klutzy. A klutz,\" he says, lookingeverywhere but at Trey. \"I'm the opposite of an athlete, theopposite of my brothers.\"
Although his speech is frequently eccentric, Matt manages to conveya very brief picture of how, because of his withdrawal, negativethoughts, and social awkwardness, people tend to leave him on hisown, both at large extended family gatherings or social functionsin his family's community and place of worship.
In his senior year of high school, Matt's grades and SAT scoresgained him entrance to a leading Midwest university-despite hisdisruptive problems.
Matt had been looking forward to going away to school, hoping thatpart of his problems \"fitting in\" had to do with his family's\"obscenely proper prominence\" in the community, and his olderbrothers' \"super-dude images, which,\" he says, \"I will never liveup to.\"
\"At the same time,\" he says during intake, \"I was also prettynervous, pretty stressed, pretty freaked out, pretty freaky.\"
In his first week of college, Matt found orientation week\"disorienting,\" he jokes with a slight smile. \"Orientationdisoriented me. It dissed me. I got dissed. There werepeople everywhere, like climbing-the-walls-and-on-top-of-youeverywhere.\"
Except when Trey first initiated a conversation, Matt, for the mostpart, has worked to avoid eye contact and continually bounces hisleft leg nervously. He is gripping the arms of his chair and looksas if he's about to fly right out of it.
\"My roommate is a jock,\" he says. \"Jocular jock. Oh, Jocularity,wouldn't you know they'd put me with ajocular-not-so-very-jocular-jock. They plan that stuff, you know.Just to keep me from escaping, from making a fresh start. Guy's ajerk, and now, here I am.\" He grins and expands his arms, gesturingthe psychiatric ward around him.
\"And now here I am, just 8 weeks into my first semester away fromhome, and I've just been admitted for totally breaking down,shooting laptop missiles from the second freakin' floor. Theywin.\"
- If Matt is truly suspected of having newly diagnosed orrecent-onset schizophrenia, should Trey be letting the conversationfocus so much on Matt's childhood? Where might intake or assessmentbe best focused?
- Based on this initial phase of Matt's intake interviewalone, what symptoms are already suggested in his behavior thatwould be significant in terms of potential psychosis orschizophrenia?
